By Melody Vallieu
MIAMI COUNTY — Across the US, from rural areas to big cities, and everywhere in between, people experiencing homelessness are caught up in the opioid epidemic.
Some begin using opioids after losing their homes — others lose their homes because of opioid use.
According to the National Institute on Drug Abuse, homelessness is a persistent problem — nearly 690,000 people are homeless on a given night in America — and it takes a terrible toll in sickness and mortality. The leading cause of death among homeless Americans used to be HIV, but that has been replaced by a new epidemic: drug overdose.
According to Miami County Recovery Council Executive Director Thom Grim some addicts start with prescription drugs offered by a doctor for an injury or other medical issue. When those are removed from the person’s life, they may turn to street drugs, such as heroin or fentanyl to fill the void.
Miami County Recovery Council’s Community Care Liaison Mike Bessler said people often then become caught up in opioid addiction very quickly.
“In some situations, we see people who became addicted by stealing their parents’ pain medications when they were teenagers and other times, we encounter folks who were given large amounts of painkillers after an injury or surgery and they become chemically dependent after a period of prescribed use and subsequent abuse,” Bessler said “In these scenarios, it becomes a matter of simple economics: heroin, and now fentanyl, have become much easier to find and cheaper to purchase, presenting as what may seem to be an affordable alternative to seeking out pain meds and paying top dollar for them.”
The downward spiral into addiction now is under way, Bessler said.
“As the compulsion to obtain and use drugs increases, people who were once rational lose sight of their personal responsibilities and boundaries,” Bessler said. “The more people lose due to their use — jobs, relationships, social status – the harder it becomes to have hope that things will ever get better. So the substance use provides a cheap and fast way to get rid of the pain people experience through loss and increased isolation.”
Grim said taking care of day-to-day expectations also begin to go by the wayside as addiction takes over, which can ultimately lead to homelessness.
“When people are into the cycle to use something every day, to stave of the addiction, things like rent, food, tend to go by the way side,” said Grim, who said the good news is the county is seeing 50 percent less calls for overdoses.
With increased use of opioids, the compulsion to use becomes stronger, but not necessarily just to feel high, Bessler said. Once someone becomes physically dependent, that person is compelled to use to stave off powerful withdrawal symptoms, according to Bessler. In this situation, Bessler said the the basic needs of someone — nutrition, hygiene and health, and shelter — are eclipsed by the drive to treat their emotional and physical pain with powerful drugs like fentanyl.
“The promise of immediate gratification becomes more important than having a safe and comfortable place to stay. The farther people are in their addiction, the more they have lost and the harder it will be to gain any of it back. It’s a cycle of mounting despair and hopelessness,” Bessler said.
Grim said many addicts are what is called “transitionally homeless,” meaning they are sleeping wherever they can — in shelters, bouncing between friends’ couches or even in their car.
“Addicts have sometimes burned a lot of bridges with their families or significant others,” Grim said. “They sometimes even burn bridges with shelters by not following the rules.”
For those working toward getting clean, their homeless status can be a big issue in moving forward toward that goal, Grim said.
“Sometimes they are staying with other people who are addicted and using. Going back into the same environment is not conducive to getting clean,” Grim said. “It’s kind of a challenge if folks are trying to pull out of this. The less they have around them, the more difficult it is. Unless a person has shelter and food, they probably aren’t going to work on their addiction.”
“People lose hope when they don’t have a stable place to stay and they are not emotionally, mentally, or physically capable of earning a living due to their addiction,” Bessler said. “The basic needs of someone who is in the throes of addiction become less important than finding and using drugs to stave off withdrawal and to temporarily get away from the chaos and misery of what life has become.”
In Miami County, those who are homeless and struggling with addiction can seek help from several resources.
Bessler said the Miami County Family Abuse Shelter, for women, and the Buckeye House, which houses men, are important allies in the effort to help and treat those who struggle with addiction.
“Sometimes, I may be working with a client who has lost everything and needs a safe and stable environment so that they can get away from the drug culture and engage in treatment. FAS and Buckeye House help when they can. In turn, FAS and Buckeye House reach out to us when they identify folks who may be struggling with addiction and we try to meet quickly with these individuals and get the connected with treatment and case management services.”
Barb Holman, executive director of the Family Abuse Shelter of Miami County, said during 2017, 29 percent of women sheltered and 34 percent of men sheltered by their agency reported experiencing some type of substance abuse issue at entry into their program. Those allowed into the shelters must seek support towards achieving recovery and all of the shelter’s programs are drug free, Holman said.
“To be in the shelter, they have to get into some kind of treatment,” Holman said. “If they are in our program, they are actively trying to address (their addiction).”
When women enter the the shelter for help, many are estranged from their children.
Holman said many of the women she encounters at the shelter seek treatment in hopes of being reunited with their children. Some of the women have handed their children over willingly to family or friends, some have had their children removed, Holman said.
“One trend we see is we have a lot of grandparents that are raising their grandchildren. That is most of the women’s plan is to get healthy, working on their sobriety and trying to get a job so they can provide a stable environment again.”
While they don’t see a lot of them, Holman pointed to a woman who OD’d in the bathroom of the Franklin House last year with her child in the room.
“That’s the worst kind of incident,” Holman said. “It’s hard on the staff, the children and the other clients.”
Bessler said by the time people have reached the late stages of opioid addiction, they have burned a lot of bridges. They have alienated friends and family, broken promises time and again, and in many cases, they have taken advantage of people who have tried time and again to provide help and support.
“Sometimes it is difficult to convince people that a person needs and deserves help and hope simply because that person is a fellow human being,” Bessler said. “Those with longstanding addictions can be challenging to find individuals and organizations to take the chance that the help someone receives at any given time might be the deciding factor that helps someone turn his or her life around and achieve long-term abstinence and recovery.”
Of course, not everyone is ready to receive help or are even aware of available services, according to Bessler. So, he said, it is a blessing that someone like Dick Steineman, who runs St. Joseph’s House in Troy, provides a safe place out of the elements for those who are particularly isolated. But, Steineman also nudges people towards help if they are open to it, Bessler said.
Steineman said he has had to call ambulances for those who have passed out during meals at St. Patrick’s Soup Kitchen and has experienced overdoses at St. Joseph’s House as well. Steineman said he knows of several women who have recently been sleeping in front of storefronts in Troy, and often receives calls from men seeking shelter from the elements.
Bessler said motels — especially those close to interstates — sometimes become havens for the sale and use of drugs.
“Still, there are a lot of folks who do whatever they can to get by. Some of them ‘couch surf,’ crashing in the homes of friends and acquaintances because they have lost their homes or their families have turned them away. People squat in abandoned homes, live in tents, and even stay out in the woods when they have lost everything.
“It’s not always out in plain sight in Miami County, but at any given time, there are people in this community who are barely surviving in the most desperate of circumstances,” Bessler said.
Help is available in Miami County for those looking to change their lives, Bessler said. He said Miami County has a number of community-based organizations that offer conventional therapeutic services, case management, and medically assisted treatment. Miami County Recovery Council and Recovery and Wellness Centers of Midwest Ohio offer direct and timely services for those suffering from addiction and Bessler said the MCRC appreciates the assistance of community partners like the Tri-County Board of Mental Health and Recovery Services and Upper Valley Medical Center, which have helped them to improve upon our outreach and response to the opioid crisis, Bessler said.
According to Bessler, one of their most important endeavors to date is the Hope House, which provides people with a safe place to stay while they go through withdrawal. In many cases, the individual might not have a safe place to go after Hope House, so the MCRC will connect these folks with a case manager who will explore housing options like FAS/Buckeye House, Franklin House, Buckeye House, and the newly opened Joshua House. Community Housing also provides assistance when possible.
Bessler said he has seen a shift in what drugs addicts are using.
Most people who started abusing opioid pain medication and transitioned to heroin years ago readily acknowledge that most “heroin” now is really fentanyl, Bessler said. Fentanyl, and variants like carfentanyl, is cheap and there’s a lot of it on the street at any given time, he said. It varies with respect to its potency, so sometimes people may accidentally overdose on a stronger form of the drug, thinking that they’re just using their typical amount of the substance. Sometimes, people seeking another drug like cocaine might accidentally purchase fentanyl and unwittingly suffer an overdose.
Based on what he sees, Steineman also believes fentanyl use is on the rise.
“It’s just a terrible addiction, people will steal from you,” Steineman said. “With fentanyl, it’s almost like playing Russian roulette. You get a bad batch, and it can kill you.”
Bessler said people also seem to be switching to meth thinking that it’s a “safe” alternative because there is no risk of an opioid overdose.
“But the effects of meth are also terrible and extensive. People can suffer psychotic episodes, become aggressive and physically violent, harm themselves and others, and get seriously hurt by the harmful chemicals that are used to produce meth,” he said. “Also, dealers are apparently mixing meth and fentanyl and ‘cutting’ these drugs with other substances to stretch their own supply. But mixing the drugs or introducing other substances presents new risks and dangers.”
Bessler said helping those who need the most assistance and support is time consuming and costly. He said as much as the community-based agencies do to this end, including the Family Abuse Shelter, Health Partners Free Clinic, and similar organizations “we can always make good use of more resources, including more affordable, safe, and habitable living spaces for people to be safe and stable as they begin to put their lives back together.”